Provider Demographics
NPI:1760564025
Name:NASH, CLARICE ALDINE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CLARICE
Middle Name:ALDINE
Last Name:NASH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CLARICE
Other - Middle Name:ALDINE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12215 RIDGEPOINT CIR NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9493
Mailing Address - Country:US
Mailing Address - Phone:360-990-3648
Mailing Address - Fax:360-698-2869
Practice Address - Street 1:12215 RIDGEPOINT CIR NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9493
Practice Address - Country:US
Practice Address - Phone:360-990-3648
Practice Address - Fax:360-698-2869
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002461363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9607607Medicaid